Mld.  m;s1 


Medical  Missionary 

Work 


AT  CESAREA,  TURKEY 


Cesarea  and  Mt.  Argeris 

By  Alden  R.  Hoover,  M.  D. 

FOR  YEAR  ENDING  AUGUST  31 

1912 


American  Hospital 

TALAS,  CESAREA,  TURKEY  IN  ASIA 


llogpital 

Physician  in  charge  . 

Assistant  Physician  . 

Ancpsthetist 

Superintendent 

Head  Nurse  .... 
Surgical  Nurse 
Nurse  in  training  . 

Nurse  in  training 
Nurse  in  training 
Housekeeper 
Night  Nurse 
Night  N}trse 
Orderly  . . 

Orderly  ...... 


^taff 

A.  R.  Hoover,  M.  I). 

(j.  K.  Gulbenk,  M.  D. 

Mr.  H AIG  Haratunian,  Ph.G. 
Miss  Theda  B.  Phelps 
Miss  Melpomene  Serinidou 
AIiss  Yeghsapet  Bijoyan 
Miss  Seranoush  Boyajian 
Miss  Lucia  Sarkisian 
Miss  Yester  Boshnakian 
Miss  Episteme  Youakimidou 
Mrs.  Theobista  Ananiadou 
Mrs.  A’eghsapet  Sarrafian 
Mr.  Nazar  Hajikian 
Mr.  Levon  Selverian 


J0is!pens!arp 


Dispenser 
Assistant  dispenser 


Mr.  Haig  Haratunian,  Ph.G. 
Mr.  Yoriyos  Youakimidou,  B.  A. 


Medical  Missionary  Work 


Talas,  a town  of  10,000  inhabitants  is  situated  practically  in  the  center  of  Asia 
Minor.  It  is  one  and  one  half  hours  from  the  city  of  Cesarea,  and  at  an  alti- 
tude of  4,300  ft.  above  sea-level.  It  commands  a beautiful  view  of  Mt.  Argeus 
on  the  one  hand,  and  the  broad  and  fertile  Cesarea  plain  on  the  other. 

Medical  work  was  started  in  Talas  twenty  years  ago  by  Dr.  William  S.  Dodd. 


TALAS 

Tlirough  his  untiring  efforts,  combined  with  those  of  Dr.  Wilfred  Post,  his  associate 
during  the  last  seven  years  of  this  time,  the  work  w'as  built  up  in  a permanent  and 
substantial  manner  and  recognized  throughout  the  country  as  one  of  the  most  important 
medical  centers  in  Turkey.  A splendid  three-story  stone  Hospital  building  w^as  erected 
also  a twm-story  stone  dispensary  block  with  rooms  for  drug-store  and  a commodi- 
ous suite  of  five  waiting  rooms  and  examination  rooms.  That  these  men  were  wise 


in  the  selection  of  Talas  as  a medical  center,  and  that  their  careful  and  efficient  work 
was  held  in  high  esteem  is  attested  by  the  following  figures  showing  the  increasing 
clientele  the  past  four  years. 


1908-09 

1909-10 

1910-11 

1911-12 

year  only) 

Number  out  patients 

2691 

3433 

1818 

3832 

Number  in-patients 

419 

460 

197 

616 

Number  surgical  operations  . 

667 

691 

299 

785 

For  some  years  past  the  former  doctors  have  contem[)lated  starting  a new  work 
in  Konia  and  one  and  one  half  years  ago  the  plans  were  completed  whereby  the 

American  Board  took  over 
the  Hospital  and  dispensary 
buildings  and  grounds  to- 
gether with  a j)art  of  the 
former  equipment,  and  the 
Talas  medical  w’ork  passed 
entirely  into  the  hands  of 
that  organization. 

These  changes  necessi- 
tated closing  the  Hospital 
for  a period  of  six  months, 
an  entire  change  in  the  per- 
sonnel of  the  Hospital  staff, 
and  the  providing  of  a new 
equipment. 

Dr.  A.  R.  Hoover,  hav- 
ing had  five  years  experience 
in  the  American  Board’s 
hospital  at  Marsovan,  was  secured  as  jjhysician  in  charge.  Miss  Theda  B.  Phelps, 
graduate  of  Illinois  Training  School,  and  afterward  sui)erintendent  of  Colonial  Hos- 
pital, Geneva,  Illinois,  w'as  secured  as  superintendent.  Dr.  Gulbenk,  graduate  of 
Anatolia  Hospital,  Marsovan,  and  of  Beirut  College  of  Medicine  was  .secured  as 
assistant  physician;  Mr.  Haig  Haratunian,  graduate  of  Beirut  College  of  Pharmacy, 
as  anaesthetist  and  dispen.ser.  These  together  with  one  trained  Armenian  nurse, 
and  a corps  of  undergraduate  nurses,  orderlies,  .servants,  and  helpers  made  up  the 
hospital  staff  and  em])loyee.s. 

It  seemed  that  all  things  were  to  work  together  for  good  for  Talas,  for  although 
a multitude  of  difficulties  stood  in  the  way  of  re-establishing  the  work,  one  by  one 


[4] 


they  have  been  in  great  part  overcome,  leaving  many,  but  such  as  are  to  be  expected 
in  any  extensive  work  in  this  country.  The  matter  of  securing  an  equipment  was  a 
most  important  one,  and  this  seemed  i)rovidentiaIly  met,  for  there  stood  waiting, 
stored  in  Constantinople,  an  outfit  of  some  two  thousand  to  three  thousand  dollars’ 
value  practically  unused,  which  had  been  purchased  for  an  American  Hospital  in 
Constantinople.  This  outfit  through  the  kindness  of  Constantinople  station  was 
secured  and  shipped  to  Talas.  The  dispensary  was  restocked  with  drugs  and  supplies 
from  London,  and  after  a period  of  inactivity  of  six  months  the  Talas  Hospital  was 
re-opened  Sept.  1,  1911. 

The  work  started  out  at  once  in  good  force,  and  before  many  days  the  hospital 
was  filled  as  far  as  its  equipment  would  allow.  The  heavy  task  of  the  fall  was  suc- 
ceeded by  steady  service  throughout  the  winter  months,  the  winter  being  of  rather 
exceptional  mildness.  This  was  followed  by  a rush  of  work  in  the  spring  which  con- 
tinued until  July,  when  as  has  been  customary  the  Hospital  was  closed  for  a few 
weeks  for  repairs  and  to  give  a brief  respite  from  strenuous  duty  during  the  most 
heated  term.  The  Hospital  was  open  for  patients  3'25  days  throughout  the  year. 
The  capacity  of  the  Hospital,  formerly  forty  beds,  was  of  necessity  increased  to 
seventy  beds.  In  this  manner  some  150  more  in-patients  have  been  accommodated 
than  formerly.  This  increase  together  with  the  small  Hospital  force  has  necessi- 
tated the  omission  of  much 
work  which  should  be  done. 

Practically  no  touring  work 
has  been  possible;  profes- 
sional visits  have  been  made 
to  some  twelve  cities  and 
villages  of  this  region.  Much 
needed  relief-work  for  poor 
has  had  to  be  neglected,  while 
many  plans  for  extension  of 
the  work  in  various  lines 
have  failed  of  execution  for 
lack  of  time.  During  the 
year  we  have  been  in  con- 
stant dread  of  cholera;  it  is 
still  raging  within  four  hours 
of  Talas,  but  so  far  the  cities 
of  Talas  and  Cesarea  have 
escaped.  An  epidemic  of 
measles  last  winter  carried  off  some  hundreds  of  young  children  due  to 
lack  of  care  during  the  period  of  convalescence.  An  incident  of  unusual  occur- 


[5] 


rence  in  this  country  was  a mad-dog  scare.  Some  twenty-four  children  of  Talas 
were  bitten.  These  children  were  taken  in  hand  by  the  Government  officials 
and  sent  to  Constantinople  where  they  were  given  serum  treatment  for  a period  of 
fourteen  days.  Among  the  Hospital  and  out-patient  cases  have  been  a number  of 
general  medical  interest,  and  these  have  been  reported  in  current  medical  literature. 

The  constituency  of  the  Hospital  is  the  most  varied  imaginable,  from  the  beggar 
in  filth  and  rags,  to  those  prominent  in  civil  and  religious  circles.  As  to  race  and 
religion,  about  one  third  are  of  Moslem  faith  and  two  thirds  of  Christian  races  while 
the  promiscuous  range  of  work  is  perhaps  best  seen  by  reference  to  the  list  of  surgical 
operations  appended.  The  unsettled  political  atmosphere  has  not  affected  work 
here  in  the  interior  to  any  material  degree.  Emigration  to  America  from  the  cities 
and  villages  of  the  whole  region  continues  unabated,  affecting  particularly  the 
Christian  races,  Armenian,  and  Greek.  This  will  mean  an  increasing  proportion  of 
Moslem  patients  from  year  to  year. 

A training  school  for 
nurses  will  be  started]  again 
after  a lapse  of  two  years. 
There  are  three  candidates  for 
the  beginning  class,  the 
course  of  instruction  to  be  three 
years.  Graduates  of  schools 
of  similar  grade  to  the  girls’ 
school  at  Talas  will  be  eligible 
to  the  training  classes,  a work- 
ing knowledge  of  English  being 
essential. 

The  distinctively  religious 
aspect  of  the  medical  mis- 
sionary work  has  been  done  in 
a purposely  quiet  and  unas- 
suming manner.  It  seems  wise 
to  us  and  consistent  with  the 
policy  of  our  Board  to  at- 
tempt to  build  up  a medical 
institution  of  such  high  standard  of  proficiency  as  shall  command  the  confidence  and 
respect  of  Moslem  and  Christian  alike.  There  is  an  attempt  to  set  an  honest  stand- 
ard of  'medical  ethics  in  the  midst  of  much  to  the  contrary,  and  first  of  all  to  gain 
confidence,  then  changed  lives.  Aside  from  personal  talks  with  patients,  daily 
morning  and  evening  prayers  are  held  in  the  Hospital  wards,  and  a short  preaching 
service  each  Sabbath  afternoon. 


THE  DISPEN8AHY 


The  gratitude  attested  by  many  is  our  best  evidence  of  the  hand  of  God  in  all 
the  work. 

We  acknowledge  with  gratitude  the  faithful  and  efficient  service  of  our  pastor. 
Rev.  Mibar  Muncherian,  in  conducting  evening  devotions  in  an  exceedingly  helpful 
manner.  We  would  also  gratefully  acknowledge  the  service  of  Mr.  Vartavar  Gara- 
bedian  in  conducting  the  Sabbath  afternoon  service  in  the  men’s  ward.  Services 
in  the  women’s  wards 
have  been  conducted  by 
various  persons,  and  to 
them  also  our  thanks  are 
due,  as  well  also  to  our 
missionary  fellow -work- 
ers of  Talas  station. 

Financially  the  Hos- 
pital has  not  yet  reached 
the  self-supporting  ideal, 
although  the  returns 
from  patients  have  been 
encouraging  in  this  field 
where  the  rich  are  few 
and  the  poor  abound. 

The  re-opening  of 
the  work  this  year  was 
naturally  attended  by 
numerous  incidental  ex- 
penses; the  American 
Board  has  generously 

made  a grant  of  $2,000  to  help  the  financial  strain.  It  is  sincerely  hoped  that  many 
friends  in  America  or  elsewhere  will  see  in  this  work  at  Talas  an  opportunity  for 
investment  which  is  yielding  great  returns.  A number  have  signified  their  desire  to 
contribute  $150  a year  for  the  support  of  one  bed  each.  Subscriptions  which  have 
so  far  reached  us  we  acknowledge  with  thanks. 


COMING  TO  THE  DISPENSARY 


Mrs.  Horace  Crawford,  Winnipeg, 
Mrs.  James  H.  Ashdown,  Winnipeg 
Dr.  C.  A.  Noland,  Ogden,  Iowa 


$100 

50 

50 


Digitized  by  the  Internet  Archive 
in  2017  with  funding  from 
Columbia  University  Libraries 


https://archive.org/details/medicalmissionarOOhoov 


Surgical  Operation  List 


Regional  Surgery 

Abdominal 

Appendectomy  .16 

Gastro-Enterostomy,  posterior  ...  9 

Entero-Enterostomy  . . . . 1 

\’olvulus  intestines  .....  2 

Chalecystotomy  .....  2 

Ventral  Hernia  .....  6 

Stab  wound  prolapse  omentum  2 

Stab  wound  prolapse  intestine,  gangrene  1 

Appendicitis  suppurative  ...  6 

Tubercular  peritonitis  . .11 

Exploratory  laparotomy  ....  3 

Hysterrectomy,  complete  inversion  uterus  . 1 

Ilysterrectomy  uterine  and  ovarian  fibroids  1 

Hysterrectomy  abdominal  ...  5 

Ventral  fixation  or  suspension  ...  7 

^’entral  fixation  and  ovariotomy  1 

Ventral  fixation  and  appendectomy  1 

Ovariotomy  single  or  double  . 3 

Resection  ovary  .....  1 

Ovariotomy  and  appendectomy  5 

Pyosalpinx  ......  2 

Pelvic  adhesions  ...  1 

Pelvic  adhesions  and  appendectomy  . 1 

Resection  Fallopian  tube  . . 1 

Dermoid  cyst  ovary  ...  1 

Adherent  ovarian  cyst  1 

Total  abdominal  ....  91 

Hernias 

Hernia  inguinal  single  or  double  36 

Hernia  inguinal  female  ....  3 

Hernia  inguinal  strangulated  ...  1 

Hernia  inguinal  strangulated  gangrenous  1 

Hernia  inguinal  and  hydrocele  . 1 

Hernia  inguinal  and  castration  1 

Hernia  inguinal  and  hernia  bladder  . 1 

Hernia  congenital  .....  3 

Hernia  femoral  .....  1 

Hernia  femoral  strangulated  ...  1 

Hernia  femoral  strangulated  gangrenous  1 

Hernia  direct  ......  1 

Hernia  double  with  traumatic  laceration  of 

hernial  sac  .....  1 

Total  hernias  .....  52 


Gynecological 

Curettage  ......  27 

Curettage  and  cervical  repair  ...  5 

.Adherent  placenta  .....  2 

.\bortion  5 mos.  foetus  ....  1 

Cervical  repair  .....  1 

Perineomaphy  .....  7 

Vesico-vaginal  fistula  ....  5 

Recto-vaginal  fistula  ....  1 

Embryotomy  ......  2 

Forceps  delivery  .....  1 

Pelvic  abscess  vaginal  ....  10 

Pelvic  abscess  groin  ....  2 

Condylomata  vaginae  ....  1 

Total  gynecological  ...  65 

Eye,  Ear,  Nose,  and  Throat 

Cataract  ......  26 

Dacryocystitis  .....  8 

Entrapion  single  or  double  ...  40 

Knapp’s  Operation  . . . . . 13 

Enucliation  ......  10 

Iridectomy  ......  9 

Soft  cataract  ......  4 

Dislocation  lens  .....  3 

Pterygium  ......  6 

Ectropion  ......  6 

Strabismus  ......  4 

Retention  cysts  .....  5 

■Abscess  eyelid  .....  1 

Tonsils  and  adenoids  . . . .12 

Radical  mastoid  .....  5 

Perforation  palate  .....  5 

Deviation  nasal  septum  ....  3 

Specific  abscess  septum  ....  1 

Nasal  polyp  ......  1 

Sarcoma  of  nose  .....  1 

Laceration  ear  .....  3 

Caries  external  auditory  canal  ...  1 

Caries  middle  ear  .....  1 

Pharyngeal  abscess  ....  1 

Total  eye,  ear,  nose,  and  throat  . . 169 

Calculi 

Suprapubic  cystotomy  . . . .10 

Total  calculi  .....  10 


9 


Amputations 
Fingers  . 
Hand 
Forearm 
Arm 

Charcot  foot 
Symes  foot 


Total  amputation 
Gunshot 

Face,  eye,  and  hand 
Hand  and  wrist 
Arm  and  forearm 
Scapula 
Back  of  neck 

Pubic  bone  and  bladder  . 
Arm,  ligation  brachial  artery 
Both  femurs  . 

Thigh  .... 
Knee  .... 
Leg  and  foot  . 

Groin  .... 

Total  gunshot  . 

Genito-Urinary 
Urinary  fistulse 
Posterior  urethrotomy 
Internal  urethrotomy 
Hydrocele  double 
Castration  single  or  double 
Hypospadius  . 

Plastic  scrotum 
Nephrectomy 

Total  genito-urinary 

Tubercular  Bones  and  Joints 
Lacrymial  bone 
Superior  maxillary  . 

Inferior  maxillary 
Orbit  and  cranium 
Ribs,  resection 
Ribs,  without  resection 
Humerus 
Glenoid 'cavity 
Radio-humeral  joint 
Resection  elbow  joint 
Resection  knee  joint 
Synovitis  knee  joint 
Hand  and  wrist 
Hand  and  foot 
Synovitis  ankle 
Ankle  bones 

Tibia  .... 
Femur  .... 


Ileum  .......  1 

Ilio-sacral  joint  .....  2 

Total  tbc.  bones  and  joints  . . 64 

Tubercular  Sinuses  and  Abscesses 

Scalp  .......  1 

Cervical  glands  .....  20 

Cervical  and  axillary  ....  8 

Cervical  and  groin  .....  1 

Axillary  glands  . . . .11 

Thigh  sinus  and  abscesses  . . .13 

Arm  .......  2 

Elbow  .......  1 

Groin  glands  ......  1 

Leg 1 

Chest  wall  ......  2 

Hip 1 

Popliteal  abscess  .....  2 

Foot  .......  1 

Loin  .......  1 

Total  tbc.  sinuses  and  abscesses  . 66 

Tumors 

Epithelioma  face  .....  4 

Lipoma  .......  5 

Cancer  lip  with  or  without  glands  . . 5 

Cancer  breast  and  axillary  glands  . . 4 

Cancer  scalp  and  neck  ....  1 

Cancer  forehead  plastic  ....  1 

Cancer  sternum  .....  1 

C ancer  perineum  .....  1 

Cancer  bladder,  supra-pubic  ...  1 

Cancer  nose,  amputation  ...  1 

Cancer  orbit  .....  2 

Sarcoma-melano,  forehead  ...  1 

Sarcoma  axilla  .....  1 

Sarcoma  testes  .....  1 

Sarcoma  occiput  bone  ....  1 

Sarcoma  thigh  .....  1 

Thyroidectomy  .....  4 

Fibroma  rectum  .....  1 

Epithelioma  back  .....  1 

Gummata  ......  1 

Fibroma  forearm  .....  1 

Epulis  upper  jaw  .....  1 

Keloid  multiple  .....  3 

Papilloma  multiple  foot  . . . 1 

Angioma  foot  .....  1 

Total  tumors  .....  45 

General  Surgery 

Lacerated  wound  scalp  ....  5 

Resection  supra-obital  nerve  ...  2 

Explosion  laceration  face  ...  1 

Gangrene  tongue  .....  1 

Hernia  cerebri  traumatic  ...  1 

Plastic  mouth  .....  2 


9 

1 

1 

2 

1 

3 

5 

2 

24 

1 

1 

8 

1 

1 

1 

1 

1 

5 

3 

3 

2 

28 

4 

3 

5 

1 

4 

3 

1 

1 

22 

1 

3 

1 

1 

5 

1 

3 

1 

1 

2 

16 

4 

4 

1 

3 

7 

3 

4 


[10] 


Noma,  lip  and  face 
Compound  fracture  skull 
Wen  of  scalp  .... 
Harelip  ..... 
Empyema,  vesection  ribs 
Thoracotomy 

Extensive  specific  ulcerations 
Old  dislocation  shoulder  . 

Deep  infection  hand 
Sciatic  foramen  injection 
Jaw  closure,  arthritis 
Abscess  neck  and  chest 
Schede’s  operation  Thoracoplasty 
Multiple  ab.sce.sses  . 

Mammary  abscesses 
Retention  cyst  umbilicus 
Hepatic  abscess 

Transplantation  bone  splint,  spine 
Suppurative  arthritis,  shoulder 
Extensive  skin  grafting 
Lacerated  wound  abdominal  wall 
Fracture  acromial  process,  compound 
Caries  tibia  .... 
Osteomyelitis  tibia 
Osteomyelitis  fibula 
Deep  infection  forearm 
Compound  fracture  tibia  and  fibula 
Simple  fracture  tibia  and  fibula 
Compound  fracture  neck  humerus 
Caries  metacarpal  bones  . 

Evulsion  thigh  (machinery) 

Stab  wound  buttocks 
Compound  fracture  thigh 
Resection  head  of  femur 
Exostosis  metatarsal  bones 
Ulceration  dorsum  foot 
Compound  fracture  ankle 
Double  club  foot,  tenotomy 


Dissecting  ^ellulitis  leg  ....  2 

Perforating  ulcer  heel,  plastic  ...  1 

Compound  fracture  foot  ....  1 

Laceration  of  foot  .....  1 

Fistula  in  ano  .....  3 

Hemorrhoids  ' . .10 

Circumcision  .....  7 

Fissure  in  ano  .....  1 

Fistula  and  repair  of  rectum  ...  1 

Fistula  and  hemorrhoids  ....  1 

Peri-rectal  abscess  .....  2 

Total  miscellaneous  ....  151 

Summary 

Abdominal  ......  91 

Hernias  ......  52 

Gynecological  ....  65 

Eye,  ear,  nose,  and  throat  . . .169 

Calculi  . ^ . . .10 

Amputations  ......  24 

Gun  shot  ......  28 

Genito-urinary  ....  22 

Tubercular  bones  and  joints  ...  64 

Tubercular  sinuses  and  abscesses  66 

Tumors  ......  45 

Miscellaneous  .....  151 

Total  operations  ....  787 


There  have  been  eleven  deaths  in  the  hospital,  two 
from  Empyema,  and  one  each  from  the  following: 
Volvulus  intestine  of  5 days  duration.  Septicemia, 
Explosion  of  powder.  Urinary  fistula,  Gastro- 
Enterostomy  followed  by  pulmonary  oedema.  Stab- 
wound  of  abdomen.  Strangulated  hernia  gangrenous. 
Suprapubic  cystatomy,  and  Pyosalpinx  from  shock. 


5 

2 

1 

1 

3 

7 

31 

2 

5 

2 

1 

9 

1 

1 

6 

1 

1 

1 

1 

1 

1 

1 

2 

3 

1 

1 

1 

1 

1 

5 

1 

2 

1 

1 

1 

1 

1 

2 


11 


